EmblemHealth and UnitedHealthcare have launched the NYCE PPO plan. It supports New York City employees, non-Medicare retirees, and eligible dependents with a more streamlined member experience.
Key Features Include:
Network And Rates
Network participation and contracted rates are determined by the location of your practice.EmblemHealth network and rates apply in these counties:
Outside these counties, use the UnitedHealthcare Choice Plus network and rates. If you have any questions and queries about it, visit the official website of NYCE PPO.
The Texas Health and Human Services Commission (HHSC) has announced that it will discontinue the Dual Demonstration Pilot Program with Medicare-Medicaid Plans (MMPs) effective January 1, 2026. The change will impact MMP members, program providers, Financial Management Services Agencies (FMSAs), and Proprietary System Operators (PSOs) across select Texas counties.
The discontinuation applies to the following demonstration counties and MMPs:
HHSC will end the existing MMP plan codes in these counties. MMP members must select a STAR+PLUS Managed Care Organization (MCO) within their service area to continue receiving services.
Members who choose to remain with the same health plan will be assigned a new STAR+PLUS plan code. For example, Molina’s MMP plan code 9J in Dallas will transition to the STAR+PLUS plan code 9F for members who stay with Molina.
HHSC has released detailed tables outlining:
| MMP Plan Code (Ending) | Plan Name | MMP Service Area | STAR+PLUS Plan Code |
| 4G | Molina Healthcare of Texas | Bexar | 46 |
| 9J | Molina Healthcare of Texas | Dallas | 9F |
| 9K | Superior Health Plan | Dallas | 9H |
| 3H | Molina Healthcare of Texas | El Paso | 33 |
| 7V | Molina Healthcare of Texas | Harris | 7S |
| 7Q | United Healthcare Texas | Harris | 7R |
| H9 | Molina Healthcare of Texas | Hidalgo | H6 |
| HA | Superior Health Plan | Hidalgo | H5 |
These references are also available in HHSC Appendix XXIX: STAR+PLUS Plan Codes and Contract Numbers.
| STAR+PLUS MCO | Service Area | STAR+PLUS Plan Code |
| Molina Healthcare of Texas | Bexar | 46 |
| Community First Health Plan | Bexar | S1 |
| United Healthcare Texas | Bexar | S5 |
| Molina Healthcare of Texas | Dallas | 9F |
| Superior Health Plan | Dallas | 9H |
| United Healthcare Texas | Dallas | S6 |
| Molina Healthcare of Texas | El Paso | 33 |
| El Paso Health | El Paso | S2 |
| Molina Healthcare of Texas | Harris | 7S |
| United Healthcare Texas | Harris | 7R |
| Community Health Choice | Harris | S3 |
| Molina Healthcare of Texas | Hidalgo | H6 |
| Superior Health Plan | Hidalgo | H5 |
| United Healthcare Texas | Hidalgo | S7 |
Beginning January 1, 2026, providers must bill services using the new STAR+PLUS MCO payer plan codes for dates of service on or after that date.
Key requirements include:
Providers can verify member eligibility and MCO assignments using:
Providers and members are encouraged to visit the HHSC Options for Medicare and Medicaid Dual Coverage webpage for further guidance. Questions related to the Dual Demonstration transition can be directed to Managed_Care_Initiatives@hhs.texas.gov.
HHSC advises all impacted stakeholders to prepare in advance to ensure uninterrupted services and compliant billing as the transition date approaches.
UnitedHealthcare has announced that it would start prior authorization of a recently created American Medical Association (AMA) procedure code involving genetic and molecular testing, starting April 1, 2026. The update is in line with the prior authorization requirements, which are already in existence in response to such genetic and molecular diagnostic tests.
The new requirement will be added to the list of in-scope genetic and molecular testing codes already present in the current list of in-scope genetic and molecular testing codes, with advance notification or prior authorization that UnitedHealthcare follows. As per the update, the new requirement was applied to the procedure code 0605U.
The change impacts participating UnitedHealthcare commercial plans and Individual Exchange plans across all U.S. states, including:
What Providers Need to Know
Prior authorization to code 0605U needs to be obtained by the healthcare providers prior to the date of service. The claims that are made but without prior approval that is approved shall not be granted, and providers will not be allowed to balance bill members on the services denied.
Providers are required to submit requests through the UnitedHealthcare Provider Portal using a One Healthcare ID. The submission process includes:
The providers with no One Healthcare ID are forced to undergo the registration process to access the portal.
UnitedHealthcare has announced that it will expand its outpatient radiology and cardiology prior authorization programs effective April 1, 2026, in response to recent coding updates issued by the American Medical Association (AMA).
Under the update, additional advanced imaging and cardiology procedure codes will require prior authorization across multiple plans, including UnitedHealthcare commercial plans, UnitedHealthcare Community Plans, UnitedHealthcare Individual Exchange Plans, UnitedHealthcare Oxford Plans, and Rocky Mountain Health Plan. The changes do not apply to UnitedHealthcare Medicare Advantage or Dual Special Needs Plan (D-SNP) members.
| CPT® code | Procedure |
| 70472 | Computed tomographic (CT) cerebral perfusion analysis with concurrent CT or CT angiography of the same anatomy |
| 70473 | CT cerebral perfusion analysis without concurrent CT or CT angiography of the same anatomy |
| 0865T | Quantitative analysis of a brain magnetic resonance image (MRI) |
| 0866T | Quantitative analysis of a brain MRI |
| 0742T | Nuclear cardiology – Absolute quantification of myocardial blood flow |
| CPT code | Procedure |
| 0795T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 0796T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 0797T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 0801T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 0802T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 0803T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 33274 | Electrophysiology implant device – right ventricular leadless pacemaker |
| 0823T | Electrophysiology implant device – transcatheter insertion of permanent single-chamber leadless pacemaker |
| 0825T | Electrophysiology implant device – transcatheter insertion of permanent single-chamber leadless pacemaker |
*Oxford Health Plans will not require prior authorization for these cardiology CPT codes.
The new requirements will not apply to advanced imaging or cardiology services delivered in:
Providers must submit and manage prior authorizations through the UnitedHealthcare Provider Portal using a One Healthcare ID. After signing in, requests can be initiated by navigating to Prior Authorizations & Notifications from the main menu.
UnitedHealthcare has advised providers to review the updated radiology and cardiology prior authorization resources and the Administrative Guide to ensure compliance ahead of the April 2026 implementation date. Providers may also access 24/7 support through live chat within the Provider Portal.
The Centers for Medicare and Medicaid Services (CMS) has brought together the leaders of the federal government, clinician societies, patient advocacy groups, and the digital health industry to create impetus around the CMS Innovation Center ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model.
The meeting was chaired by the U.S. Department of Health and Human Services (HHS) Deputy Secretary Jim O'Neill and CMS Administrator Dr. Mehmet Oz, and included the other federal authorities, including the U.S. Food & Drug Administration (FDA). Conversations with the aim of increasing technology-enabled care adoption and also making payment systems consistent with better patient outcomes were discussed.
One of the principal elements of CMS's strategy is the ACCESS Model, which aims at modernizing the digital health ecosystem of the country and empowering Medicare beneficiaries with broad access to innovative health technologies. Though technology to transform chronic care has already been available, CMS pointed out that the payment mechanism has been lacking to support the process. The ACCESS Model is created to overcome this gap by rewarding results but not activities.
The model is set to commence in July 2026 and will provide Original Medicare providers and patients with high-value and technology-supported care options in ways that would prevent and manage chronic conditions. These are high blood pressure, diabetes, chronic musculoskeletal pain, and depression- conditions that afflict almost two-thirds of Medicare recipients. The model is structured to integrate with the broader healthcare system, allowing primary care and other clinicians to refer patients to ACCESS participants as an extension of their care teams.
CMS also highlighted strong interest from the health technology sector, noting that more than 350 technology-enabled care organizations have already submitted their intent to apply to participate in the model.
In addition, the FDA presented its newly announced Technology-Enabled Meaningful Patient Outcomes (TEMPO) pilot. Under this initiative, manufacturers of certain digital health devices will collaborate with ACCESS participants to provide devices for covered care while collecting and reporting real-world performance data. The pilot is intended to help both CMS and the FDA better understand how digital health technologies perform in real-world settings and how they can support improved outcomes for people living with chronic diseases.
A wide range of clinical societies, patient organizations, and payer groups expressed support for CMS’s efforts, including:
CMS stated that organizations interested in expressing support or applying to participate in the ACCESS Model can visit the model’s official website and complete the interest form.
With the new requirement, every child should take blood lead tests at 12 and 24 months. Moreover, testing must be done on children with a history of 24 to 72 months without prior test documentation. Repeat or additional testing, is also required among children who live in high-risk settings, such as in old housing or environments with known lead exposure.
This policy supersedes the risk-based screening policy used in the state of Michigan and indicates the emerging evidence that lead exposure in the community is possible not just in the traditionally high-risk regions. It is vital to detect it early because when children are exposed to lead, they may have developmental, cognitive, and behavioral impairments in the long run.
The requirement is consistent with the recent changes in updated HEDIS Lead Screening in Children (LSC), the measure that follows the percentage of children tested for lead by the age of two. The LSC measure falls under the Child Core Set of Medicaid quality reporting.
To remain compliant, pediatric practices must ensure:
The state health officials recommend the following steps be taken by the providers:
Resources and Support
Providers can also access support through the UnitedHealthcare Provider Portal.
In a major change to make care access simpler, UnitedHealthcare announced it will eliminate prior authorization on certain radiology and cardiology services starting Jan. 1, 2026.
The update will eliminate the need for prior authorization for nuclear imaging, obstetrical ultrasound, and echocardiogram services in various plan types at UnitedHealthcare. The change is applicable to the UnitedHealthcare commercial plans, Community Plans, Individual Exchange plans, UnitedHealthcare® Medicare Advantage plans, and Rocky Mountain Health Plan products.
The elimination of requirements of prior authorization covers the following:
The UnitedHealthcare Provider Portal offers 24/7 live chat assistance to providers who have questions or need additional support.
Texas Health and Human Services Commission (HHSC) has introduced a significant update to Medicaid providers stating that the Medicaid identification (ID) number of the mother can be applied where a mother has her newborn and has yet to receive a distinct Medicaid ID. The reminder is issued after the adoption of House Bill 3940, enacted during the 89th Legislature, Regular Session, 2025.
With this provision, providers can proceed to provide newborn care and charge it immediately so that babies can have the opportunity to access covered services promptly as enrollment processing is being conducted. HHSC has recommended providers to educate mothers and expectant mothers about this allowance because it would enable them to get services for their newborns immediately after birth.
Parents and caregivers will also be given a new written notice that confirms that newborns are automatically eligible as beneficiaries under Medicaid and that providers are permitted to temporarily use the Medicaid ID of the mother until the child is assigned a unique ID.
The annual notice focuses on providers of Texas Medicaid who deal with the regular care of pregnant women and newborns. HHSC suggests distributing the update to all of the relevant staff in order to implement it efficiently.
The Information for Parents of Newborns booklet and A Parent’s Guide to Raising Healthy, Happy Children are available on HHSC’s Maternal and Child Health Publications web page.
Providers may call the TMHP Contact Center, 800-925-9126 to get more information.
Beginning in early 2026, MassHealth will require MCEs to conduct more stringent claim-accuracy checks before sending encounters through SENDPro. It will help prevent claims rejections and reimbursement delays.
With immediate effect, refer to the table and apply the revised guidelines before filing claims with UnitedHealthcare. Compliance will aid in seamless processing and prompt reimbursement.
| Name | What it Means | What Goes Wrong | What Providers Should Do |
| Taxonomy codes | Shows the provider’s specialty and is linked to the NPI. | Claims without the correct taxonomy code (except pharmacy claims) are turned away. | Add the appropriate taxonomy code for every attending, rendering and billing provider on medical encounters. |
| National Provider Identifier (NPI) | Helps MassHealth match the provider and service location accurately. | Claims are rejected when an NPI is missing, unless it’s an atypical provider who doesn’t receive one. | Enter the full 10-digit NPI for all required provider roles, billing, attending, referring, rendering and operating. |
| Admit/discharge dates/times | Shows how long a member stayed in inpatient care. | Claims get denied when the admission date or hour is missing or incorrect (depending on bill type). | Review bill type rules and include the correct admission hour and date on inpatient claims that require them. |
| Primary diagnosis codes | Explains the main reason for the visit. MassHealth will soon publish an approved list. | Claims are denied if the primary diagnosis code is inactive or not allowed for the date of service (for example, F02.80). | Use valid and updated diagnosis codes and check that all fields and procedure codes are correct. |
| Occurrence codes | Provides added details about the patient’s condition or history. | Rejections occur when the occurrence code doesn’t match the member’s actual situation. | Choose occurrence codes that properly reflect the member’s condition and clinical context. |
| Revenue codes | Identifies the type of service billed. | Invalid or non-reimbursable revenue codes cause rejections. MassHealth has already marked revenue code 779 as invalid. | Verify codes against the MassHealth fee schedule before billing and avoid codes that aren’t reimbursable. |
| National Drug Code (NDC) | Universal identifier of the drug’s manufacturer, product, and package size. | Missing/invalid NDC data for physician-administered drugs. | Make sure the claim has the 11-digit NDC, the right unit of measure, and a quantity above zero. |
Providers can reach support anytime through 24/7 chat in the UnitedHealthcare Provider Portal.
Starting Jan 01, 2026, New Mexico’s Senate Bill 249 will require managed care organizations (MCOs) to repay health care providers for the gross receipts tax (GRT) they owe on Medicaid services delivered to that MCOs’ members. This reimbursement rule does not apply to non-profit providers or to claims involving prescription drugs, durable medical equipment, or specific medical codes that are already exempt from tax.
UnitedHealthcare’s remittance advice notices will include the gross receipts tax (GRT) and the service payment as two separate, clearly itemized lines.
Providers can reach support anytime through 24/7 chat in the UnitedHealthcare Provider Portal.
